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Climate change: a great threat to health, but not as generally conceived

Climate change was called this century’s greatest threat to health in the longest paper ever published in The Lancet; and this paper is frequently cited by people advocating for increased action in this area. This sentiment has been echoed in the recent Doctors for the Environment Australia report, No time for Games: Children’s Health and […]

Climate change was called this century’s greatest threat to health in the longest paper ever published in The Lancet; and this paper is frequently cited by people advocating for increased action in this area. This sentiment has been echoed in the recent Doctors for the Environment Australia report, No time for Games: Children’s Health and Climate Change, in which Professor Fiona Stanley states that “the impacts of inadequate action for their children verge on the apocalyptic and are too scary to contemplate.”

However, most of the health literature appears to not take it seriously – after all, if climate change genuinely is “this century’s greatest threat to health” then shouldn’t we be arguing that resources should be diverted from hospitals, medicines and primary care towards efforts to reduce this threat – an argument that is conspicuously absent from the mainstream health literature. Does this mean that the Lancet’s claim is wrong or do most mainstream experts, not only from health, medicine and even political science have their heads in the sand when it comes to the devastating effects of climate change on health?

In the following piece Professor Colin D Butler from the University of Canberra argues that the apparently opposed positions on climate change can be resolved – at least to some extent – by broadening our conceptions of the causal mechanisms of climate change.

Professor Butler writes:

Prior to the 2009 Copenhagen climate change conference the Lancet published a 41 page article called “Managing the health effects of climate change”. The text postulated that “climate change is potentially the biggest global health threat in the 21st century” but the executive summary was unambiguous: “Climate change is the biggest global health threat of the 21st century”. Later this month, in the lead up to the Paris climate change summit, the Lancet is to again publish a major report on climate change and health. I had no role in either, though I edited a recent book on the subject.

A WHO-led study found that in 2000 the burden of disease (BOD) of climate change caused about 5.5 million lost disability-adjusted life years (DALYs), mainly due to climate change-related undernutrition, with minor contributions from infectious diseases. This sounds significant, but was less than 0.4% of the global BOD in 2000. In contrast, HIV/AIDS, the leading cause of lost DALYs in the “baseline” scenario for 2030, contributes about 12% of the total – or about 30 times as much as climate change in 2000. Climate change is a risk factor, not a disease, so it is likely to cause an increased BOD for several health conditions. However, each of those conditions (such as undernutrition) has several causes; attributing the fraction that climate change is responsible for is bound to be disputed. Tobacco smoke, closely followed by childhood underweight, was found to be the leading risk factors in an updated BOD study published in 2013, each causing about 8% of the total burden, or about 20 times as much as that of climate change in 2000.

The claim that climate change will emerge as the greatest threat to global health this century is striking and surely calls for strong evidence, if to be taken seriously. But though some health workers do take it literally, my contention is that most don’t. Outside health, even fewer do. I suggest several explanations.

The first may lie with the Lancet paper itself. It is vague, repetitive, and in part overstated. At one point it comments “a 13-m rise [in sea level] would cause the flooding and permanent abandonment of almost all low-lying coastal and river urban areas. Currently, a third of the world’s population lives within 60 miles of a shoreline and 13 of the world’s 20 largest cities are located on a coast. More than a billion people could be displaced in environmental mass migration.” That sounds plausible, except that neither the IPCC nor any other authority suggests any such extent of sea level rise is likely this century. Few if any peer reviewed articles suggest more than 2 metres of sea level rise this century is plausible. A perception of exaggeration may reduce the impact of this paper, contrary to the authors’ intention.

The Lancet paper identifies six main health effects from climate change: (1) changing patterns of disease and morbidity, (2) food, (3) water and sanitation, (4) shelter and human settlements, (5) extreme events, and (6) population and migration. However, no attempt is made to rigorously quantify the health effects for any of these. I can understand why, but this risks creating a perception of “hand waving”.

Another reason for the comparative lack of impact of this paper is that although its authors are consciously inter-disciplinary, the consensus in many other disciplines is far more conservative. This is exemplified by the issue of conflict. The possibility that climate change may contribute to violent climate was first raised in the health literature in 1989 (in a Lancet editorial), but has rarely surfaced since. A recent paper, by 26 leading gatekeepers to the political science literature confirmed the resistance of this discipline to this idea, although, outside political science, the idea is gaining more currency. The 2009 Lancet paper also reviews the literature at that time concerning food security and climate change. While not quantifying the risk, the message is consistently more downbeat than that of the IPCC reports, though the 2013 IPCC food chapter is less optimistic than its predecessors. If disciplinary specialists do not share the anxiety of the Lancet authors then why should generalists?

There is another reason that neither health workers nor the wider community takes the Lancet paper’s claim seriously: general incredulity. Conceding that our species is capable of critically undermining the environmental and social determinants that make civilisation possible appears to stretch our species’ collective cognitive capacity. While many scientists (such as Will Steffen in this excellent recent lecture) and an increasing number of lay and business people (including Elon Musk) do understand this – and are rightly apprehensive, about “business as usual” the understanding that most of the world’s population has of climate science seems not much better than of evolution a century ago. Adding to this difficulty, of course, are powerful vested interests that deliberately confuse and cloud public understanding and, to an extent, inherent scientific conservatism.

The final explanation I’d like to raise here is of causal attribution, also related to cognitive biases. The late Professor Tony McMichael coined the term “prisoners of the proximate” to encourage his epidemiological colleagues to think more deeply about cause. Of course, McMichael was not the first to do this; causal theory is as old as philosophy. However, despite this vintage, many people, including scientists, get stuck with their preconceptions, and many have trouble conceding not only that there may be additional causal factors, but that these may co-exist with, rather than supplant their current causal preference. This tension is obvious concerning conflict. Military theorists are happy to conceive climate change as a “risk multiplier” for conflict, but not (yet) political scientists.

Climate change can indeed be conceptualised as the most important risk to health this century, but it is only one element in a risky milieu. Lowering the risk from climate change requires reducing the risk of many of its co-determinants of civilisation health. Among these, the most important factor may be complacency.